Portal Hypertension

Portal hypertension is high blood pressure of the portal vein. The portal vein is
located in your abdomen. It collects nutrient-rich blood from your intestines and
carries it to the liver. The liver cleans the blood for your body to use.

When you have portal hypertension, the increased pressure means it is harder for the blood
from the liver to flow through the portal vein to travel back to the heart. This means
it has to use smaller veins in the esophagus, stomach, and intestines. The body also
forms new vessels for the blood to flow through. These smaller and newly formed veins may
be much weaker than the portal vein and may swell up and burst under the added pressure.

Symptoms

Having a higher than normal pressure inside the portal vein can lead to a number of
related symptoms and complications. These include:

Enlarged liver and spleen

Varicose veins of the esophagus and stomach, which can cause abnormal bleeding, such
as vomiting of blood

Internal hemorrhoids

Weight loss from malnutrition

Ascites, or fluid buildup in the abdomen

Kidney malfunction

Low platelets

Fluid on the lungs

Causes

These are the most common cause of portal hypertension:

Cirrhosis, or scarring of the liver. This blocks the blood flow in the liver and leads
to portal hypertension.

Clotting of the portal vein

Clotting of the veins in the liver

In developing countries, one of the most common reasons is an infection called schistosomiasis

Diagnosis

Unfortunately, healthcare providers can’t measure high blood pressure in the portal
vein with a cuff as they can regular high blood pressure. If you are at risk for or
already have cirrhosis, your healthcare provider will likely do various lab tests,
X-rays, and endoscopic exams to see if you have portal hypertension.

Treatment

Healthcare providers treat portal hypertension in several ways. You might need to
take beta blockers, or medicines that improve how your heart and blood vessels work.
These medicines often also reduce the risk of bleeding from swollen veins. If you
have internal bleeding because of portal hypertension, your healthcare provider might
inject medicine into the vein to help stop the bleeding. Or he or she may place bands
around veins to stop the bleeding.

In more severe situations, your healthcare provider may treat portal hypertension
with shunting. This involves putting stents in the portal vein to open it and improve
blood flow. Shunting can be done with or without surgery. Surgical shunting can cause
more complications than the nonsurgical method.

A liver transplant may be needed.

Complications

The small veins overloaded because of portal hypertension can burst and cause internal
bleeding. This usually happens where the esophagus and stomach meet. This complication
can cause sudden, explosive vomiting of blood. It can be fatal.

Fluid buildup in the stomach can cause you to feel full quickly, leading to weight
loss and malnutrition. The discomfort from carrying all that fluid can also reduce
how well you can get around. The changes in blood flow sometimes lead to serious kidney
problems.

Lung problems can also result.

When to call the healthcare provider

Portal hypertension is a dangerous condition with severe, life-threatening complications.
Call your healthcare provider immediately if you notice any of these symptoms: